10/06/07 Email from Beverly Quint, LICSW, BCD to AAPCSW:
I am writing to acquaint you with a new program that many so called ancillary mental health providers (meaning all non MDs who are credentialed to treat mental health and substance abuse clients) feel is a huge threat to the survival of our professional identity. Some of you may already know of it; others may be hearing of it for the first time.
It is called TOP (an acronym for Treatment Outcomes Package from Behavioral Health Labs, or BHL). It was instituted in Massachusetts in September 2007 and is the product of Blue Cross/Blue Shield of Massachusetts which is that State's largest health care insurance company. It consists of a system whereby patients are asked to fill out a three page form detailing the most complete and intimate details of their lives; sexual, ethnic; financial and send it to the insurance company. The therapist's fee is adjusted to the compliance of the patient. If a certain percentage of your patients chooses to take time to fill out the forms and is willing to disclose details to the insurer, you, the therapist, will be reimbursed at the current rate. If a stated percentage of your patients rejects the plan, you will be paid at less than that rate.
There have been other recent incursions by insurance companies into the privacy of the patient/therapist treatment relationship, but none as thoroughly invasive and none tied to a dollar incentive that puts both therapist and patient in a lose-lose situation. Either the therapist hides the financial factor from the patient and, consciously or unconsciously, is tempted to coerce the patient to conform, or, alternatively, discloses the situation to the patient, who is then put in the middle. The patient must then choose between guarding his/her own privacy or forcing the therapist to lose his/her livelihood.
While it is true that we ancillaries come from different theoretical backgrounds, as well as from different educational institutions, we have in common that therapy is about building an intimacy between people in which trust is established. Building this therapeutic alliance takes time. The insurer, with an insistence on limiting psychotherapy to behavioral symptoms adjusted to socially acceptable "norms" within a carefully doled out time frame, is no longer dealing with specific individuals and their feelings. The patient is being socially engineered to fit the requirements of the insurer.
And what might those requirements be.? Though the insurer talks of this new TOP program being devised for the benefit of the patient, surely the end result to the insurer can not be ignored. This is especially true when their own, BHL Website discloses that there is no proof of any good to the patient having been done in the 30 states in which the program is being tried The end result to the insurer is tremendous financial power; the ability to manipulate through information, the ability to dictate behavior. In this matter it should also be noted that the insurer's best partner for securing swift behavioral symptom control is the pharmaceutical industry.
So what can we do? We, a small group of therapists in private practice on the north shore of Boston, do have some options which we have only just begun to explore. They are the usual political, legislative and informational. You, however, our colleagues, are our greatest hope. If you can respond to this email and let us know who you are, what you think of the situation herein described, whether you can identify groups already working on the problem, we might make a difference. I know you're out there. I have already signed at least one of your letters on the subject. We need to know more and to work together. Any questions.? Comments.? It is not too late to make a difference.
